Abstract
Golfer’s elbow (also known as medial epicondylitis) is caused by repetitive microtrauma to the flexor tendons of the forearm in a manner analogous to tennis elbow. The pathophysiology of golfer’s elbow initially involves microtearing at the origin of the pronator teres, flexor carpi radialis, flexor carpi ulnaris, and palmaris longus. Secondary inflammation may become chronic as a result of continued overuse or misuse of the flexors of the forearm. The most common nidus of pain from golfer’s elbow is the bony origin of the flexor tendon of the flexor carpi radialis and the humeral heads of the flexor carpi ulnaris and pronator teres at the medial epicondyle of the humerus. Less commonly, golfer’s elbow pain originates from the ulnar head of the flexor carpi ulnaris at the medial aspect of the olecranon process. Coexistent bursitis, arthritis, or gout may perpetuate the pain and disability of golfer’s elbow.
Golfer’s elbow occurs in individuals engaged in repetitive flexion activities, such as throwing baseballs or footballs, carrying heavy suitcases, and driving golf balls. These activities have in common repetitive flexion of the wrist and strain on the flexor tendons resulting from excessive weight or sudden arrested motion. Many of the activities that cause tennis elbow can also cause golfer’s elbow.
Keywords
tennis elbow, medial epicondylitis, ulnar nerve entrapment, ulnar tunnel syndrome, ultrasound guided injection, nonsteroidal antiinflammatory drugs, diagnostic ultrasonography, golfer’s elbow test
ICD-10 CODE M77.00
Keywords
tennis elbow, medial epicondylitis, ulnar nerve entrapment, ulnar tunnel syndrome, ultrasound guided injection, nonsteroidal antiinflammatory drugs, diagnostic ultrasonography, golfer’s elbow test
ICD-10 CODE M77.00
The Clinical Syndrome
Golfer’s elbow (also known as medial epicondylitis) is caused by repetitive microtrauma to the flexor tendons of the forearm in a manner analogous to tennis elbow. The pathophysiology of golfer’s elbow initially involves microtearing at the origin of the pronator teres, flexor carpi radialis, flexor carpi ulnaris, and palmaris longus ( Fig. 39.1 ). Secondary inflammation may become chronic as a result of continued overuse or misuse of the flexors of the forearm. The most common nidus of pain from golfer’s elbow is the bony origin of the flexor tendon of the flexor carpi radialis and the humeral heads of the flexor carpi ulnaris and pronator teres at the medial epicondyle of the humerus. Less commonly, golfer’s elbow pain originates from the ulnar head of the flexor carpi ulnaris at the medial aspect of the olecranon process. Coexistent bursitis, arthritis, or gout may perpetuate the pain and disability of golfer’s elbow.
Golfer’s elbow occurs in individuals engaged in repetitive flexion activities, such as throwing baseballs or footballs, carrying heavy suitcases, and driving golf balls. These activities have in common repetitive flexion of the wrist and strain on the flexor tendons resulting from excessive weight or sudden arrested motion. Many of the activities that cause tennis elbow can also cause golfer’s elbow.
Signs and Symptoms
The pain of golfer’s elbow is localized to the region of the medial epicondyle ( Fig. 39.2 ). This pain is constant and is made worse with active contraction of the wrist. Patients note the inability to hold a coffee cup or use a hammer. Sleep disturbance is common. On physical examination, tenderness is elicited along the flexor tendons at or just below the medial epicondyle. Many patients with golfer’s elbow exhibit a bandlike thickening within the affected flexor tendons. Elbow range of motion is normal, but grip strength on the affected side is diminished. Patients with golfer’s elbow have a positive golfer’s elbow test result. This test is performed by stabilizing the patient’s forearm and then having the patient actively flex the wrist. The examiner then attempts to force the wrist into extension ( Fig. 39.3 ). Sudden severe pain is highly suggestive of golfer’s elbow.
